C10012025 / invoice 10000

Reason: Not EatingClient Present:scott and karenNurse:mnVaccination Type:declinedIntestinal worming:milproHeartworm Prevention: milprFlea Prevention: bravecto spot onTick control: utdMicrochip:yesInsurance and Healthy Pets Plus:hppBehaviour concerns:noCurrent medications:bgeransaReason:presentation for inappetence and droolingbloods revealed elevated pancreatic enzymes, suspicious for pancreatitisadmission for intravenous fluid therapy, pain relief, and further diagnostics including abdominal ultrasoundHistory:presenting for inappetence since last night and droolingowner reports she is wet underneath the chinrefused hand feedingno vomitingpassed malodorous faeces just prior to consultowner reports she appears to be in pain, sitting and panting last nightimpact on daily activities: not as interactive or bouncy as usualrelevant medical and surgical history: previous history of colitis, inflammatory bowel disease (ibd), haemorrhagic gastroenteritis (hge), two intervertebral disc disease (ivdd) surgeries within one week, and toe removal due to an ingrown nail, previous mass removal (pathology results not on file)eddu: eating - no, drinking - yes, urinating/defecating - yes, malodorous faecesparasite control: currentpre-existing conditions: colitis, ibd, allergies/sensitivities to medications loseccurrent medications or supplements: previously on steroids for colitis, not currently administeredowner reports no other concerns todayExamination:Body Condition Score: 5/9GENERAL: qar, quiet temperament, well-hydrated, mm pink and moist, crt <2sHEART: hr normal, regular heart sounds, no obvious murmurs or arrhythmias, strong and synchronous peripheral pulsesRESP: rr normal, lung fields clear on auscultation - no crackles or wheezing, normal effort and no obvious nasal dischargeEARS: external exam only - no discharge, no odour, no obvious inflammation or irritationEYES: clear chambers, no discharge, LHS pigmented cornea from previous burring at specialistABDO: abdo soft and supple on palp, no palpable organomegaly, or masses but painful craniallyLYMPH NODES: no peripheral lymph node enlargement on palpORAL: mild plaque build-up and gingivitis observedMSK: good general conformation and ambulatory on all four limbs, patellas bilaterally firm, no hind dew claws, good range of motionINTEGUMENT: fur and coat in good condition, no ectoparasites on skin, scar noted from previous mass removalUROGENITAL: no umbilical hernia, entire, vulva appears grossly normalLaboratory:bloods were taken for in-house testing yesterday:> biochemistry:significant findings: elevated pancreatic enzymes (lipase, amylase)- mild increase in ALT and AST, cbc OK. - usg 1.040CBC - Blood gases and CBC in house todayCBC - mild haemoconcentration Bloods gases OK PH 7.364 and lactate normal, electrolytes all normal Ultrasound - oedematous pancreas which is swollen. Gall bladder walls normal, very minor sludging of the bile. Assessment:presented for inappetence and lethargy. blood results show elevated pancreatic enzymessuspected diagnosis: pancreatitisdifferentials include other gastrointestinal diseasehistory of ibd, colitis, hge, and multiple drug sensitivities complicates managementTreatment:admission for hospitalisationIV fluids - maropitant and methadone. Plan:discussed admitting for intravenous fluid therapy to improve circulation and support organ healingplan to perform an abdominal ultrasound to assess the pancreas and gallbladder, as gallbladder inflammation (cholecystitis) can also elevate pancreatic enzymespain relief will be administered, likely methadone, given sensitivity to other drugsan anti-nausea injection will also be given as it has shown to be well-tolerated and can assist with visceral paina "less is more" approach to medication will be taken due to previous adverse reactionsprognosis and further management will be determined after ultrasound and response to initial therapyoptions for overnight care were discussed: discharge for home monitoring, remain in-clinic on automated fluids, or transfer to an emergency centre for attended care. this decision will be made later today based on clinical progressdiscussed referral to sash (dr james king for surgery, dr ninette  keller and dr lisa singer for medicine) if escalation of care is required.PM assessment - brighter, urinated normally and passed normally formed faced but was dark brown in colour. No further vomiting temp at 38. More comfortable.Offered food - chicken at 2:30pm - only very limited interest in warmed chciken. Has maybe one mouthful. Plan send to Sash. For ongoing care and transfer to specialist care for full abdominal ultrasound    Vital Signs    Weight: 10.8;       Temperature: 38.4;